The Magic and the Mystery of Skin-to-Skin

by Alice Callahan on October 2, 2013

I meant to do skin-to-skin with Cee after her birth, I swear. It was in my birth plan. But after a long labor, Cee was born blue and limp, and the understandable concern about her health trumped any ideas I’d had about optimizing our postpartum experience. Cee was whisked away to a warmer on the other side of the room and encircled by the NICU team. Thankfully, I heard her cry within a few moments, and she was in my arms soon after. But by then, she was wrapped in a pink and blue flannel blanket, and I was too overwhelmed and taken with her to think of unwrapping her. Instead, I held her, and we gazed into each other’s eyes. She started rooting and was nursing within a couple of minutes. It was a magical first meeting, and it wasn’t until later that I realized that I’d screwed up and forgotten to do skin-to-skin.

What’s wrong with this picture? (besides the fact that I hadn’t slept or brushed my hair in 48 hours)

I’ve been researching this topic for a chapter in my book about the postpartum period. I’m writing about what we know and don’t know about getting to know our newborns, establishing breastfeeding, rooming in, and yes, skin-to-skin. When I started working on this chapter, I thought the skin-to-skin thing was a slam-dunk, maybe even too obvious to be of much interest to my readers.

Modern-day interest in skin-to-skin, also called kangaroo care, began in 1978 in the NICU at San Juan de Dios hospital in Bogotá, Columbia. For every 10 premature babies born there, only 3 survived. There weren’t enough incubators or nurses. Babies were tucked two to three at a time in incubators, and infections were rampant. Parents weren’t encouraged to be involved in the babies’ care, and having little emotional connection to them, many abandoned their sickly babies at the hospital. Kangaroo care was a desperate attempt to care for these vulnerable babies. Mothers were essentially asked to be their babies’ incubators, holding them skin-to-skin 24 hours per day and breastfeeding on demand.

The results were astounding. The kangaroo care babies in Bogotá grew well, were more likely to be breastfed, and were less likely to get severe infections or be abandoned. The power of kangaroo care for low birth weight babies has since been confirmed in multiple studies. A 2011 Cochrane review concluded that skin-to-skin helps stabilize premature newborns, reduces mortality, infections, hypothermia, and length of stay in the hospital. These benefits are particularly clear in developing countries, but many hold in industrialized nations as well.

With the impressive success of skin-to-skin care for preemies, it seemed natural to assume that full term babies would benefit from it as well. But the research in this area is disappointing. Much of it is of poor methodological quality, made more complex by the fact that you can’t blind study participants to whether they received skin-to-skin or “usual care.” There’s no placebo for skin-to-skin. And “usual care” varied tremendously, depending on whatever was the protocol in that time and place, and trust me, there have been a lot of weird ideas about how to treat newborns.

Let me give you a few examples. These studies are often cited as providing evidence that skin-to-skin contact is essential for helping newborns transition to the outer world:

1. A 1990 Swedish study by Righard and Alade, published in the prestigious medical journal The Lancet, concluded that babies that had one hour of uninterrupted skin-to-skin with mom immediately after birth had better breastfeeding “technique.” Of 38 skin-to-skin babies, 24 had good technique at the first feed. In the control group, the babies were held by mom for 20 minutes, then taken away for some routine procedures in the delivery room for another 20 minutes, and then returned to mom. Of the 34 infants in the separation group, only 7 were deemed to have good breastfeeding technique. But there are two HUGE, unfortunate holes in this study design: it wasn’t randomized and it wasn’t blinded. The mothers and their midwives decided whether they should be in the skin-to-skin group or the control/separation group. Can you see the problem with this? Might there be some other factors at play here, things that could be different between moms who say, “Yes, absolutely, I want to hold my baby!” or those who say, “Eh, you can take her for a while,” or those who are simply too exhausted to care? And might the investigators, judging the babies’ sucking technique, possibly be biased towards which group they think should be better feeders? These are big problems, and quite frankly, they make this study useless. And yet, it’s cited all the time.

2. In Christensson et al. 1992, 50 mothers giving birth at a Madrid hospital were randomized to skin-to-skin or separate care groups. The skin-to-skin group had 90 minutes of skin contact after birth, and compared to the control babies, they did better in lots of ways. They were warmer, had lower respiration rates and higher blood glucose, and they cried less. But how were the control babies treated? They were tucked into a hospital bassinette and then LEFT THERE for 90 minutes. The control parents were explicitly asked NOT to pick up or feed their babies. So of course the control babies didn’t do very well! Since their parents were forbidden to soothe them, they cried more, breathed faster, and burned away their blood glucose under that stress. It made me angry to read this study; it’s unethical and wouldn’t be allowed today. And it tells us nothing about how babies do when they are wrapped in a blanket and held, or placed in a bassinette but picked up for comforting and feeding.

3. Finally, there’s this fascinating study conducted in Japan in 2002 and published by Mizuno et al. in 2007. In this study, 30 newborns had 50 minutes of skin-to-skin and a chance to breastfeed right after birth, and the control group was given “usual care.” What was usual care at this hospital? NO contact with the mother for 24 hours after birth. Mom basically got to say, “Hi, baby!” and was then instructed to rest for the next day while baby stayed in the nursery and was fed formula. After that first day, baby roomed in with mom and breastfed on schedule every 3 hours. Importantly, the skin-to-skin babies also followed usual care after their 50-minute snuggle and chance to breastfeed.

The babies were then tested at 1 and 4 days of age to see which smells they preferred – mom’s breast milk, another woman’s milk, formula, orange juice or water. (Picture paper towels soaked in each of these liquids, suspended above baby’s head. Whichever one baby spent more time smacking her lips at was deemed the preferred smell.) In both groups of babies, breast milk was preferred on day 1, but they didn’t differentiate between their mother’s milk and that of a stranger. On day 4, the skin-to-skin babies had a preference for their own mother’s milk, but the control babies still didn’t seem to differentiate their mom’s milk from the stranger’s. The skin-to-skin babies were also breastfed longer (about 7 months) compared with the control babies (about 5 months).

The results of this study are kind of cool, and they fit with other research that shows that babies have a heightened sense of smell in the hour or so after birth. And the differences in breastfeeding duration were impressive. But again, like the Christenson study, the experimental paradigm of 24 hours of separation is just so strange. This was just a decade ago, folks. (I have no idea if this practice is common in Japan today.) Regardless, this study tested the effects of complete mom/baby separation with near-complete separation, and thankfully, neither situation is relevant to parents giving birth in even the least-progressive hospitals in the U.S. today.

I chose these three studies because they illustrate the problems with skin-to-skin research, but they aren’t unique. A 2012 Cochrane review of skin-to-skin for healthy babies (i.e., not preemies) included 34 studies (including the second and third described above) but noted that NONE of them met Cochrane’s criteria for methodological quality. The main problems cited were the risk of bias and the variability in protocols for what it meant to have skin-to-skin or “usual care,” as illustrated in the above studies. Despite these problems, the review authors went ahead with a slew of meta-analyses. They did find a small but significant improvement in the number of skin-to-skin dyads breastfeeding between 1 and 4 months of age compared with the controls. However, there wasn’t evidence that skin-to-skin improved the success of the first breastfeed, the number of moms exclusively breastfeeding at discharge from the hospital, or the number of babies still breastfeeding at one year. The results are rather wishy-washy with lots of warnings not to put much stock in them due to small sample sizes and high variability.

Well, I felt discouraged after reading all these studies. I was really hoping to come out of my research with a sort of evidence-based protocol for a happy postpartum experience. Instead, I was beginning to feel like the emphasis on skin-to-skin contact for full term babies has been sort of overblown. I know that sounds crazy, and believe me, I don’t want to be the party-pooper who ruins something as sweet as mother and babe, skin against skin, in the first moments of life outside the womb. But I’ve read study after study on skin-to-skin, and there’s no getting around it: the science just isn’t that good.

What I learned, more than anything, was that it was impossible to look at this science without becoming entangled in history and culture. These studies, conducted over the last several decades, tell a story of where we have come from. We’ve come from an era of over-medicalized childbirth, in which women were largely removed from the process of childbirth and from caring for their babies in the postpartum. Babies were whisked off to nurseries, thought to be better for infection control (they weren’t), only having short visits with mom for scheduled feedings. In the 1970’s and 80’s, with a growing appreciation for the value of breastfeeding and the parent-infant bond, moms pushed for more mother-infant contact, skin-to-skin, breastfeeding on demand, and rooming in. There are likely many reasons why these changes were really good for families, but they are surprisingly difficult to tease apart in the studies. And like the studies I described above, where usual care was maternal deprivation, they don’t mean much to us now.

I thought it might help me sort this out to look further into the past, to try to understand how families welcomed babies before obstetricians and hospitals came onto the scene. I had this idea that surely uninterrupted skin-to-skin contact was the universal postpartum routine of our ancestors. But I was wrong here, too. A survey of anthropological records of non-industrial societies, going all the way back to 1750 B.C., found that skin-to-skin contact after birth was observed in only 14% of them. If there was anything universal about their postpartum practices, it was that most bathed both mom and baby soon after birth (surprising to me), and most babies stayed in a quiet room with their mothers for a few days or a week after birth.

So what does this all mean to today’s parents, seeking a meaningful postpartum experience? To me, it means that the postpartum can’t be reduced to a list of optimal practices, like boxes to be checked. We absolutely should be able to hold our babies and to keep them close as we get to know one another. That should be facilitated and encouraged in all birth settings. If we learn anything from these weird studies, it’s stuff we probably already knew: don’t leave your newborn in a bassinette to cry, and don’t wait 24 hours to try breastfeeding for the first time. Do snuggle your baby, feed her, and soothe her when she cries. Do know that you are important to your baby, and that this is just the beginning of a long and beautiful relationship. Skin-to-skin may help with all of this, but do it because it feels good, not because you think it’s scientifically proven or the natural way of our ancestors.

It also helps to remember that we humans are extraordinarily flexible animals. Sometimes childbirth is scary and traumatic, and rarely is it predictable. It’s been like that throughout the course of human history, and it will always be that way to some degree. One thing that worries me when we start talking about the “optimal” childbirth and postpartum experience is that when things don’t go as planned, moms might feel like they failed their babies in some way. But if mom can’t hold the baby, for whatever reason, then dad, other mom, auntie, friend, grandpa, doula, midwife, or nurse can take over. What’s important is for baby to be cared for by responsive caregivers. There is not a magical formula for that. It is just about families being with babies.

I’ve been reading too many studies on this topic, and I’m ready to hear some real-life stories! What was your postpartum experience like? Did you do skin-to-skin, and if so, do you think it was helpful? What else helped ease your transition to parenthood and your baby’s transition to the outside world?

Hospital policy changed between my first and second births. My daughter was born in 2008 by c-section and she was given to my husband to hold. When I delivered my son (also by c-section) in 2011, I was told he would be given to me immediately, if possible, for skin-to-skin. It was a totally different initial post-partum period for me. I felt disconnected from my daughter, breast feeding was difficult, my supply was awful and I had to supplement. I also ended up having PPD which really didn’t help things. With my son, on the other hand, it was completely different. I felt bonded to him immediately and we had a wonderful breast feeding relationship. I truly believe that those immediate minutes of skin-to-skin contact made all the difference.

Thanks for commenting ~ I’m really glad to hear your story! I think that one problem with the science is in study design, as I discussed in the post. But the other issue is just that there are so many variables that go into some of these BIG outcomes, like breastfeeding difficulties and bonding. I have no doubt that skin-to-skin makes a difference to many moms and babies, but it isn’t really showing up convincingly in the studies. There is one outcome that is really convincing, at least in one study: maternal satisfaction. Moms who had skin-to-skin were way more satisfied and much more likely to say that they’d like the same type of care in the future than those that had the usual delivery room protocol of intermittent contact. http://www.ncbi.nlm.nih.gov/pubmed/15740818 That’s a really important finding, I think.

I felt disconnected from my first born son, breastfeeding was difficult, I felt pretty miserable and ended up with PPD. And he was a vaginal delivery with immediate skin to skin contact. With my fifth, I felt a powerful and immediate surge of intense love as soon as I saw him, breastfeeding went perfectly smoothly and his in the only birth where I didn’t suffer PPD afterwards. He was born by an emergency cesarean and I didn’t get skin to skin contact until we got to the recovery room. I would be very careful about assuming causation in your two experiences.

I didn’t do skin-to-skin with my first, but with my second, I had a whole goal of it happening. I was at a birth center but ended up being a hospital transfer. They had to whisk him away for suctioning (meconium) but when they brought him to me, they unwrapped him and tucked him against my bare skin. My labor was difficult and finally having him against me calmed me. Then I had a retained placenta and so I had to pass him off to my husband while they performed a manual removal. I made my husband take off his shirt (he was happy to do so for our baby LOL) 🙂 Over all, having my baby against my skin helped me feel okay in the moment. It’s really the only positive memory have from that period of my labor (up until the ambulance it was nice and after that it was hell). I’ve tried to do skin to skin a couple of times since then (he’s now two months) to help me when I feel overwhelmed from my negative emotions from his birth.

I don’t know if there’s much science to it, but I definitely *feel* better when his little body is against mine and he’s content.

It’s on topics like these that I feel there is some real value to anecdotal evidence. It really doesn’t matter what the science says if you felt like skin-to-skin helped you and your baby. There was the study I mentioned in my comment above to Dr. Mom that found that maternal satisfaction was higher with skin-to-skin. I also think part of the value in encouraging skin-to-skin is that it tells the parents that they’re important, that they can be soothing to their baby just by being there and holding their baby. It’s not a fancy piece of gear or something even like swaddling that can take some practice – it’s just you, and to your baby in that moment, it’s probably enough.

I am so moved by your beautiful story, Shannon. It’s really wonderful that skin-to-skin helped you when you relived your very difficult labour.

I had a very smooth labour and delivery and I had skin-to-skin contact with my daughter as soon as she was born, but I was so overwhelmed by the whole experience (and her deafening screams!) that I’m sorry to say I don’t really remember how it felt. Luckily, I have a couple beautiful photos from those moments, and I can kind of re-imagine what it was like. 🙂

In any case, my take-away from Alice’s post is that we deserve better than to beat ourselves up about anything that didn’t go exactly as planned. As she said, much of this amazing process is unpredictable, and we do the best with the unique situation that presents itself as our babies come into the world.

Jenn, exactly! I think our current ideas about how the postpartum should go are great, for the most part (even if the science backing them isn’t amazing), and I’m so glad we have the options that we have today. But a small byproduct of these expectations can be disappointment when things don’t go as well, and we still have a lifetime to get to know our babies.

Fascinating! I always suspected skin-to-skin was one of those things that we want to be “objectively” good but that the current preference for it really has to do with cultural factors. It reminds me of researchers being “disappointed” when their study showed that pacifiers didn’t seem to interfere with nursing (even though that sounds like a win-win to me).

I had a quick and easy delivery, and my son was placed right on top of me for skin-to-skin time. It was wonderful, and it felt nice, but it did nothing to help with breastfeeding. My son definitely did not have good “technique” so I guess we buck the trend of the 1st study. I had milk, but he just couldn’t get any, and trying to nurse was stressful and sometimes left both of us crying. By the end of the week, my son was finally able to nurse with the help of a silicon nipple shield. About 2 weeks later, I was able to ditch that. What got him to nurse after all? Not skin-to-skin, but 5 days of 24-hour midwife assistance in the hospital, helping me supplement with formula, providing constant encouragement. I gave birth overseas, and was allowed to stay until I felt comfortable with my son’t weight gain. I truly believe that if I had delivered in the US, I would have given up nursing. (While that would have been sad for me, I think my son would have been fine either way).

Ultimately, I think skin-to-skin is great when it’s possible, but real bonding and trust will happen over many years.

Yes! I also think it is cultural in the sense that we really put a high value on building a relationship with our kids from the start. That probably wasn’t so much the case historically, when moms knew that there was a pretty good chance their babies wouldn’t make it through the first year. When I was reading the anthropological accounts of postpartum practices, I was amazed to find that some non-industrial cultures would introduce the baby to the rest of the camp before mom even had a chance to hold him! It was also common to have another lactating woman nurse a newborn until mom’s milk came in. But in a culture like that, developing relationships within your small community was probably felt to be a very important thing, and it showed from the first minutes of life.

I’m glad I’m not the only one who finds this fascinating. It sure would make a much nicer story to have really clear science showing that skin contact is absolutely beneficial to newborns, though:)

My son was born at 29 weeks – completely unexpectedly. I managed to avoid C-section, just, but had been prepped that he likely would not breathe on his own at birth. Luckily he came out crying (!) and did so well that after those NICU checks he was placed on me for 30 seconds before being whisked to the NICU proper where he would stay for the next 70 long days.
We didn’t get to touch him for 3 days. Even when we did get to kangaroo care, he was hooked up to dozens of wires, and weighed just 2 lbs 9 oz. I was excited and terrified at the thought of getting to do it, and I had been on edge and jumpy after 3 days of worry and very little sleep. I have never felt more calm as the moment the nurse placed him on my shirtless chest and walked away. A wave of peace washed over us both, he settled in and his vital signs smoothed and regulated. We kangarood every day after that, and it is one of my favorite memories of the NICU. I had to go home every night and leave him, and set an alarm to wake up every 3 hours to pump milk. Kangarooing was the thing that made me feel most like a mum.

Wonderful story. I’m so glad that kangaroo care is encouraged for premature babies now. For too long, doctors thought that preemies should be touched as little as possible to protect them from infections. I can’t imagine having a baby and not being able to touch her for weeks or months. Involving parents with kangaroo care and in other care-taking activities really helped. Based on the science and many stories from parents, it makes a huge difference – not just to the baby but also the parents, who get to be involved in their baby’s care and begin to build a relationship.

You know, as lovely and natural as skin-to-skin IS, I’m glad to hear that it doesn’t appear to be a necessary part of the bonding/breastfeeding experience. I was on pain meds and had pushed for two hours with my daughter, so I was exhausted and drugged when she was born. They put her on me but then took her across the room for examination. We had no problem bonding and I nursed her for 14 months before I decided to wean her.
When my son was born, he was briefly shown to me but the cord had been wrapped around his neck and he wasn’t breathing so there was no chance for skin-to-skin even if we’d wanted to. Again – bonded well and breastfed for 16 months. 🙂
With our third, I had a completely natural (no meds or interventions) birth but it was so intense that once he came out, I was in shock! lol I held him with a blanket covering him on me for a little while and he nursed sooner than our other childre had. He and I bonded the same and I am still nursing him at 25 months old.
I don’t think that birth or what follows immediately makes or breaks the bond between mother and baby OR their future breastfeeding experience.
Great article!

I honestly can’t remember if I got to do skin-to-skin with either of my children. I remember WANTING to do it, and knowing it was a good/important thing to do but the whole “the baby is out and the contractions finally stopped” phase is a blur to my memory now. Sooooo let’s just say I did it, and it was awesome and my kids are amazing today because of it, k?? 😉

I live in Mexico and My two babies were c-sections. I had no chance of skin-to-skin with either of them. In fact, here in Mexico, (at least in most private hospitals), of you had a c-section you will be “awake” while they pull your baby out, they make a quick check on your baby, then they show you your baby and put him/her next to your face so you can kiss him/her (moms are still tied up, legs and arms, to the surgery table), and they take your baby to a complet check-up. Dads can go with the baby.
Moms are still tide up, and they put you to sleep and finish the surgery. Then moms go to the recovery room… You wake up alone there. After a while they take you to your room… And only after all that they bring you your baby. This is maybe 3-4 hrs or sometimes even more, after your baby is born.
When all this happend to me I did not like it, but never questioned it since “this is how it is done”. Now, after writing it, I want to cry. How did I let all this happen without not at least say something?
Thank God my two kids (almost 3 and 8 months) are healthy and I did not have any problem brestfeeding, and my bonding with both of them did not suffer…
(sorry for my bad spelling and grammar, English is not my first language).

I really learned a lot from my research on this topic about the variation in practices around the world when it comes to caring for newborns and new moms. Your experience would have been fairly common in the U.S. just a decade or two ago. I hope that things get better for families in your area soon. It’s good perspective to me after getting bogged down in analyzing the science. Whatever the studies say, you’d rather have the chance to hold your baby, right!? That should really be enough to convince us that we should all have the opportunity to do so.

I am a mommy of premie twins, emergency C-section. I was not allowed (or limited to one hour a day) skin to skin after birth and for most of their time in the hospital. The reason for this, given by the nursing staff, was that it was stressful on the babies. Personally, I felt it was stressful for the babies not to be held and lots of handling by the nursing staff was stressful for them! I was in the nursery everyday until they were released and as the days went on I was able to hold them more (still one hour cap per time, and it also depended on the nursing staff-some followed the rules strictly and some did not). Don’t get me wrong, the nursing staff and doctors were great, however, do wish things could have been done differently. I do wonder how much of that has affected my relationship with my babies. (They had other problems as well) my daughter never latched on, but my son did. My daughter isn’t as cuddly as my son. I cuddle with them as much as possible now!!!

I’m sorry that you had this experience. It sounds like the hospital where you gave birth was really behind in this area. I saw this article recently about family-centered NICU care in Toronto. Here’s a quote and a link at the bottom if you want to read more. Seems like a great idea to me!

“The program was instituted following a 2011-2012 pilot project in which the parents of 40 newborns were asked to spend a minimum of eight hours a day in the NICU and tasked with the overall management of their child’s care.

That included bathing and changing diapers, monitoring the infant’s vital signs, and recording feedings and weight gain on their medical chart. Nurses were responsible for the medical side of care — looking after feeding tubes, adjusting ventilation apparatus and administering medications.

The babies’ progress was compared with those whose care was primarily provided by nurses, and Lee says “the results were phenomenal.”

“There was a 25 per cent improvement in weight gain of the babies who were looked after by the parents,” he says. “Breastfeeding rates doubled from 40-something per cent to over 80 per cent. Infection rates fell from 11 per cent in the nurse group to zero in the parent group. Treatment errors dropped by 25 per cent. Parental satisfaction went up, parental stress went down.

“So these were good results.”

While parents are encouraged to cuddle their infants for periods throughout the day — skin-to-skin contact not only provides comfort but also promotes a baby’s physical and neurological development — nurses and doctors keep handling to a minimum to avoid transferring germs from one little patient to another.

“Parents are the ones in charge, so nobody gets to touch their baby without their consent,” stresses Lee.”

I agree with the commenter above – my daughter was born and whisked off too the NICU. Nothing that horrible (just an infection & fever), something that a strong round of antibiotics took care of in 5 days, but scary for a first time mom nonetheless. While I wasn’t able to be with her the few 6 hours, we did kangaroo care in the NICU (complete) with wires and all, everytime we got to see her, and it really helped me feel like a mom – connected to my baby and help calm us down. Additionally, having the one-on-one NICU nurses to encourage and teach me how to breast feed really strengthen my nursing relationship.

My son and I did skin-to-skin for a couple of hours after his birth at the hospital 2 weeks ago. Because we were in the care of midwives, we went home 4 hours after he was born. Once at home, there were visitors wanting to hold him and it was chilly weather in the evenings so I kind of forgot about skin-to-skin and he stayed dressed in a diaper shirt and pjs. On his second day home, we noticed that despite being bundled his skin was always very cold. We gave him a warm bath and then I spent about an hour of skin-to-skin with him and then my husband spent another hour or so. After that, he was toasty-warm for the next couple of days – we had to remember not to bundle him as much as we had been doing or he’d get all sweaty! I think skin-to-skin helped him regulate his temperature. He seemed to get cold again a few days later so we repeated the same routine and he has been a nice warm baby ever since!

Wow, this is a fascinating story, Carolyn. There are a few studies that consistently show that babies that are skin-to-skin are just a tad warmer than those that aren’t. Some researchers dismiss this as not being “clinically significant,” but I suspect that it is important to at least some babies. Sounds like it worked well for your little one!

The only time I ever really did skin-to-skin with my daughter was in hospital breastfeeding classes. It never felt natural to me. She was born via emergency c-section (not my first choice by far, but when your child goes into distress you do what you have to do) and Dad held her first. It was over an hour before they let me hold her and even then my temperature was having trouble stabilizing so skin-to-skin wasn’t an option. After that it always seemed more natural for me to be clothed and for her to stay wrapped up. Her pediatrician was always happy with her health. We still successfully breastfed for almost 14 months when mother-led weaning concluded (I will say that a lot of this has to be attributable to my daughter – she had a strong suck and an insatiable appetite and she loved to nurse). She is a complete mama’s girl. I feel bonded to her, though I wouldn’t describe our bond as instant love. I don’t feel that not really doing skin-to-skin had any impact on us.

I’d also like to speak up in defense of the hospital nursery. I had a kid who was born to be a stomach sleeper. She hated the swaddle and had a strong Moro reflex. She never had a honeymoon period of sleeping well. By night 3 of my hospital stay both my husband and I were exhausted. Being able to send my daughter from our lovely recovery room to the nursery for one 3 hour stretch between breastfeeding sessions was the only good sleep I got for months to come. I was glad that rooming in was the default at my hospital, but also oh-so-grateful for the nurses who soothed my unable-to-sleep baby for a few hours.

I also sent Cee to the nursery for a few hours the one night that we spent at the hospital. Looking back, that seems a little strange that I would make that choice, since we were basically inseparable from then on for many months. She wasn’t that fussy like your baby, and she probably slept for most of the time that she was at the nursery. But I was just really really tired after being in labor for two nights, and my husband was too. I was grateful for the chance to sleep knowing that she was in good hands. Like you, I think that rooming in should definitely be the default, but I agree that parents should have the option to have a break if needed.

I’m glad you put your story into the mix. Like most things with parenting, you do what feels good and what works for you, right?

Great article! I also did skin on skin, and as some other mom’s here, I felt it was soothing and calming for both me and the baby, and after giving birth for months I would do skin on skin from time to time.She had no problems with breastfeeding,although I had a bit of problems with milk supply. In the end I nursed her for over a year, so all went well 🙂

I was stuck in recovery 4 hours after my baby was born from an unplanned c section, and I was not allowed to see her. I had planned on skin-to-skin all along, and I was heart broken I was not able to do it.

Fortunately, she rooted instantly when placed in my arms, and her latch was perfect.

I still regrets that we did not have that time together, but it did not hamper our connection or breastfeeding relationship.

My daughter was born four weeks early via emergency c section, and even though the hospital talked a good game about skin-to-skin, she was still handed to me all bundled up. Once I was out of surgery, though, we spent the next several days snuggling, and established a good breastfeeding relationship, and she’s a great little trouper at four months now. I really valued our skin-to-skin time but at the same time, I don’t know if it was the contact or just the loving responsiveness our physical closeness allowed that gave us such good outcomes.

What about the length of the umbilical cord? Surely it’s likely that, until the recent past, skin-to-skin (or at least mother holding the baby immediately) was the norm, presumably until the cord stopped pulsing or the placenta was delivered. Cords are typically just long enough for the baby to be held to the mother’s breast or stomach.

Both my sons were born at home in a pool, I caught them as they swam up to me then held them skin-to-skin and fed them in the lovely warm water. It’s really special to me that I was the first person to touch and hold both of them and the memories of their first hour or so will always make me feel calm and happy just to think of them. It seems bizarre that (all being well) anyone might have tried to take them from me, cover them up or perform any unproven culture-determined rituals (have you seen those awful films of healthy newborns having tubes pumped up their nostrils?). Both were/are breastfed as long as they wanted, the first stopped at two and the second is still feeding happily at about 20 months.

That’s a great point. I agree it’s probably safe to say that baby would be on mom for a few minutes, until the cord stopped pulsing, in pre-industrial societies. But after those few minutes, the anthropological study that I cited described a wide variety of practices, and skin-to-skin was surprisingly rare.

There are other physiological reasons I can cite as to why it makes the most sense for mom and baby to be together, skin-to-skin or not (and why not?!). Most babies are born with elevated stress hormones, and they’re super alert for about the first hour. There is some research showing that they have a really heightened sense of smell and smell memory during that time. It seems smart to take advantage of this period of alertness to get to know one another and attempt breastfeeding. After about the first hour or so, baby gets sleepy… I don’t think that first hour is necessarily irreplaceable if it isn’t possible for mom and baby to be together during that time, but it definitely seems optimal.

I’m glad you had all the skin-to-skin you wanted with your little ones!

Since most pre-industrial societies would have been (by our standards) pre-presonal hygiene, perhaps the lack of skin-on-skin and the prevalence with immediate washing was due to the increase in skin infection transmission that had been observed… Although it isn’t a scientific study, you might be interested in reading the memoir _Call the Midwife_ about birthing practices in 1950s London for more historical annecdotes about birth and post-partum practices.

My perpetual complaint about these studies is this: the results that they measure – length of time breastfeeding, being able to distinguish the smell/taste of mother’s milk, etc – are all just ASSUMED to be beneficial to the infant. I never wanted to aim for an optimized infant; my goal is the optimized adult. Are we just adding stress to the mother-child relationship by spending so much time and energy on things that won’t matter when the child is in kindergarten, let alone in high school? I think I know the answer without asking – but have any of these studies shown any impact long term? Or even on a quantifiable heath outcome?

I had a quick and relatively easy labor and delivery for my twins at 36 weeks. Since there were two, it wasn’t possible to do immediate skin-to-skin time with the first. I was honestly so tired and overwhelmed that I didn’t push for it even after they were both born. Or it may have been hospital policy for late-premies to be examined first – I can’t remember. We did get some skin-to-skin time a few hours later and we tried out breast feeding. They were so tired that they weren’t able to get enough or latch very well. I also welcomed the opportunity for them to sleep in the nursery at night so I could get the last two nights of rest I figured I would get for several months. I, too, would be very interested to learn if there were any long-term effects from the initial mother-child bond that is formed with skin-to-skin time, breast feeding, etc. Does said bond remain just as strong later in life even with so many other life factors coming into play?

For my first pregnancy, I was pushed to induce, went through 3 days of failed pitocin before my twins were born by c-section. I got to look at them briefly before they went off with dad – even though they were full term and I had asked to do skin to skin in the OR. My awesome doula had them skin to skin and tandem nursing within 5 min after they were brought to me in the recovery room. Other than milk that was a little delayed, I had no real nursing problems and breastfed two until 18 months. But I had so many regrets with that birth.

For my second pregnancy, I tried and failed at a VBAC. Before the birth, I pushed for skin to skin contact in the OR while I was sewn up. They didn’t like the idea of unwrapping her in the cold OR, but my husband held her sweet face up to mine and they didn’t push us to whisk her off. But, I was so tired and having trouble breathing. So I asked my husband to take her away. I then got a little nap while they sewed me up. And then I spent the whole night with her on my chest, skin to skin, and it was lovely.

What happened was basically the same for both births, I got a quick look at my babies but didn’t get to hold them until the recovery room. But because I made the choice the second time, it felt different. And I don’t have all the resentment.

I think this is such an important point, and your story illustrates it beautifully. How mom feels about the experience is important, and we shouldn’t really need to prove that any one practice is beneficial in the long-term to babies (so long as it doesn’t pose a risk). If moms like skin-to-skin and doing it isn’t keeping baby from getting necessary medical attention, moms and babies should be able to have that time. If they don’t want it or need to just rest for a while, there is no reason to feel guilty about that choice. But the choice part is important – I agree.

I didn’t have or want really skin to skin with any of my kids. I was happy to receive a clean and bundled baby to hold after my csections. We had breast feeding issues but it was due to me not producing enough not because of a lack of skin to skin time with the baby. I am glad that things have changed and there are more options for women. I do think that hospitals should not be so quick to get rid of well baby nurseries. Not every woman has a partner that is able to help with the baby and mom need some sleep to help with recovery.

I think skin-to-skin is great if you want to do it and have the opportunity. I can’t see the harm, even if the greatest benefits are for preemies. As for bonding, we are humans, not geese and we do not imprint like waterfowl. Humans form bonds with lots of other humans over time…fathers, grandparents, aunts/uncles and siblings all love the new baby and (most) will develop strong bonds with it, and they never breastfeed it, and most of them probably won’t do skin to skin. Adoptive parents love their children, and as adults we form loving bonds with other adults, romantic bonds and friendship bonds. Humans are pretty complex and resilient creatures, and the first few moments or hours after birth aren’t going to make or break the bond a child has with its mother or anyone else.

I developed HELP syndrome the day that the doctors decided to induce me. I was over 38 weeks and baby was fine. I had some skin-to-skin time before they did the cleaning off and measuring routines. Then we had more skin-to-skin and first nursing. I really enjoyed the time with my son although I don’t know what long term effects it would have I know that I would have a bond even if I couldn’t have that time. I felt instantly connected to him anyways and felt almost empty when they took him to the nursery for his bath and newborn tests (I had a good labor and delivery, but sort of had a BP crash about 2 hours after delivery and had to stay in the labor and delivery room until I was stabled with my BP and hydration). It was the weirdest feeling for him to be away from me.
He had some issues with latching don’t know if it was because of his smaller size 5lbs 3 oz. or if it was unrelated, but for me the skin-to-skin didn’t automatically solve that issue.
My personal opinion is that even if science doesn’t have specific benefits for it if the mother enjoys it is a sweet great first moment with baby. If the mother isn’t able or doesn’t want to I don’t think that it will be damaging to the baby either though.

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Welcome! I'm the author of The Science of Mom: A Research-Based Guide to Your Baby's First Year, published by Johns Hopkins University Press in 2015. I write about science, health, parenting, and nutrition here and for other print and online outlets.
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